scholarly journals Low Carriage Rates of Multidrug-Resistant Organisms in Prospective Stool Donors in a Large Fecal Microbiota Transplantation (FMT) Stool Bank

2020 ◽  
Vol 41 (S1) ◽  
pp. s85-s86
Author(s):  
Amanda Zaman ◽  
Taha Qazi ◽  
Pooja Pai ◽  
Tricia Peters ◽  
Susie Nicolaysen
Keyword(s):  
Risk Factors ◽  
Clinical Assessment ◽  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
International Travel ◽  
Resistant Organism ◽  
Donor Screening ◽  
Stool Samples ◽  
Stool Bank

Background: Fecal microbiota transplantation (FMT) has emerged as standard of care for Clostridioides difficile not responsive to antibiotic therapy. Rigorous screening of healthy donors is critical to patient safety. As part of routine donor evaluation for FMT, multidrug-resistant organism (MDRO) screening is performed to assess the presence of extended-spectrum β-lactamase–producing organisms (ESBLs), vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Carriage rates of these organisms in a healthy, low-risk population are largely unknown. We report MDRO carriage rates among individuals screened for a stool donation program at a large-scale FMT stool bank. Methods: Individuals were screened at a nonprofit stool bank (OpenBiome, Cambridge, MA). Potential donors underwent in-person clinical assessment, including MDRO risk factors (eg, travel, occupation, healthcare exposure). If they met the clinical assessment criteria, laboratory testing, including MDROs, was performed. Once enrolled in the donor program, donors underwent repeated clinical and laboratory screening at 60-day intervals, with intermittent health checks throughout the donation period. Stool samples provided at 60-day intervals were screened for MDROs (ie, ESBL, CRE, VRE), and nasal swabs for MRSA were tested using culture-based methods. All stool samples tested for MDROs from prospective and enrolled donors were included. Results: Between February 2017 and July 2019, 247 individuals were screened for MDROs. Overall, 11 samples (0.04%) tested positive for ESBL, MRSA, or VRE. No CRE carriers were identified. Also, 2 individuals tested positive twice for ESBL, resulting in 13 of 1,688 (0.77%) positive screens. International travel in the previous 12 months was reported by 6 of 11 MDRO carriers. Occupations typically associated with MDROs were not observed in carriers. Most of the MDRO-positive donors were students; however, students make up the majority of the stool donor cohort. Conclusions: This study is the first to report background MDRO carriage rates in a population of otherwise healthy FMT stool donors. Although rare, MDROs were detected and should be part of standard guidelines for FMT donor screening. Most subjects testing positive for MDROs had defined risk factors associated with MDRO carriage, including international travel or exposure to healthcare environments. However, occupational exposure was not a factor associated with carriage in this study. Standardized donor screening guidelines for FMT are urgently needed to ensure that MDROs and risk factors for MDRO carriage are routinely screened for by all FMT providers. Stool banks present a unique public health opportunity to evaluate the background carriage rate of MDROs in healthy populations.Funding: NoneDisclosures: None

scholarly journals 109. Differences in Gram-Negative Antibiotic Susceptibility Among Patients Receiving Fecal Microbiota Transplant for Clostridioides difficile

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S1-S1
Author(s):  
Michael Woodworth ◽  
Tiffany Wang ◽  
Divyanshu Raheja ◽  
Alex Waldman ◽  
Rachel Friedman-Moraco ◽  
...  
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Statistical Tests ◽  
Antibiotic Resistance Gene ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Resistant Organism ◽  
Fecal Microbiota Transplant ◽  
Gram Negative ◽  
Clostridioides Difficile ◽  
Signed Rank

Abstract Background Decreases in multidrug-resistant organism (MDRO) colonization and antibiotic resistance gene abundance have been reported after fecal microbiota transplantation (FMT), but data on clinical microbiology culture and susceptibility results after FMT are limited. Methods We retrospectively reviewed the available microbiology results for patients who underwent FMT for recurrent Clostridioides difficile infection (RCDI) at Emory University from July 7, 2012 until December 2017 and had microbiology results within 1 year pre- and post-FMT. Demographic and clinical characteristics were abstracted by trained reviewers, and statistical tests of differences in central tendency were tested with Wilcoxon signed-rank tests. Results Of 236 unique patients undergoing FMT during the study period, 18 had growth of Gram-negative bacteria on culture pre- and post-FMT. Of these, 8 had Gram-negative growth in urine culture (the most common site) pre- and post-FMT. Fourteen (14/18, 78%) patients were female, 4/18 (22%) were black, 14/22 (78%) were white, and 18/18 (100%) were non-Hispanic. The mean number of CDI episodes prior to first FMT was 4 (range 3–7 episodes). Differences in counts of susceptible, intermediate, and resistant susceptibility test results before and after FMT are shown in Figures 1 and 2. Although a trend in reduction of resistant reports is visually suggested, this was not statistically significant by Wilcoxon signed-rank testing (P = 0.10 for all cultures, P = 0.21 for urine). Ten patients had pre-FMT micro results and no micro results after FMT, but reduction of count of infectious syndromes in FMT could not be tested with this study design. Abstraction of viral quantitative PCR results did not suggest clinical recognition of new infection or reactivation of viruses after FMT. Conclusion FMT may reduce clinical burden of antimicrobial resistance, but statistically significant differences in resistance were not detected in this study. Further study with RCTs is needed. Disclosures All authors: No reported disclosures.

scholarly journals Stool banking for fecal microbiota transplantation: methods and operations at a large stool bank

2020 ◽  
Author(s):  
Justin Chen ◽  
Amanda Zaman ◽  
Bharat Ramakrishna ◽  
Scott W Olesen
Keyword(s):  
Median Time ◽  
Fecal Microbiota Transplantation ◽  
Improve Patient Care ◽  
Fecal Microbiota ◽  
Screening Guidelines ◽  
Donor Screening ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Improve Patient ◽  
Stool Bank

Objectives: Fecal microbiota transplantation (FMT) is a recommended therapy for recurrent Clostridioides difficile infection and is being investigated as a potential therapy for dozens of microbiome-mediated indications. Stool banks centralize FMT donor screening and FMT material preparation with the goal of improving the safety, quality, convenience, and accessibility of FMT material. Although there are published consensuses on donor screening guidelines, there are few reports about the implementation of those guidelines in functioning stool banks. Methods: To help inform consensus standards with data gathered from real-world settings and, in turn, to improve patient care, here we describe the general methodology used in 2018 by OpenBiome, a large stool bank, and its outputs in that year. Results: In 2018, the stool bank received 7,536 stool donations from 210 donors, a daily average of 20.6 donations, and processed 4,271 of those donations into FMT preparations. The median time a screened and enrolled stool donor actively donated stool was 5.8 months. The median time between the manufacture of an FMT preparation and its shipment to a hospital or physician was 8.9 months. Half of the stool bank's partner hospitals and physicians ordered an average of 0.75 or fewer FMT preparations per month. Conclusions: Further knowledge sharing should help inform refinements of stool banking guidelines and best practices. 

scholarly journals Fecal Microbiota Transplant Mitigates Adverse Outcomes Seen in Patients Colonized With Multidrug-Resistant Organisms Undergoing Allogeneic Hematopoietic Cell Transplantation

2021 ◽  
Vol 11 ◽  
Author(s):  
Andrew J. Innes ◽  
Benjamin H. Mullish ◽  
Rohma Ghani ◽  
Richard M. Szydlo ◽  
Jane F. Apperley ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Adverse Outcomes ◽  
Hematopoietic Cell ◽  
Matched Pair ◽  
Resistant Organism ◽  
Fecal Microbiota Transplant

The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in 25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant differences and statistically comparable patient/transplant characteristics, as the sample size was small, a matched-pair analysis between both groups to non-MDRO colonized control cohorts (2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4% versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their paired non-MDRO-colonized cohort. Conversely, there was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2% respectively, p=0.24) between the FMT-MDRO group and their paired non-MDRO cohort. Collectively, these data suggest that negative clinical outcomes, including mortality associated with MDRO colonization, may be ameliorated by pre-HCT FMT, even in the absence of intestinal MDRO decolonization. Further work is needed to explore this observed benefit.

Challenges of Screening Prospective Stool Donors for Fecal Microbiota Transplantation

2020 ◽  
Vol 23 (1) ◽  
pp. 21-30
Author(s):  
Nancy E. Dubois ◽  
Catherine Y. Read ◽  
Kelsey O’Brien ◽  
Kelly Ling
Keyword(s):  
Clinical Assessment ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Assessment Process ◽  
Future Research ◽  
Laboratory Assessment ◽  
Screening Process ◽  
Screening Programs ◽  
Donor Screening ◽  
Institutional Adoption

Despite high efficacy rates, significant costs and logistical challenges associated with procuring stool from healthy donors for fecal microbiota transplantation (FMT) have presented barriers to broader institutional adoption and limited the availability of this life-saving treatment. Published outcomes for donor screening programs report donor deferral rates between 90% and 96%. Due to the paucity of FMT donor screening data, a secondary analysis on a cohort of previously screened donors (n = 7,968) was conducted to provide a synopsis of the observed trends and rationales for prospective stool donor deferrals. Upon completion of the evaluation, 1.7% of prospective donors (n = 134) qualified for stool donation. Over 50% of donors who completed the online pre-screen were deferred, primarily for a body mass index of 30 kg/m2 or greater (n = 1,516, 37.0%), logistics (n = 841, 20.5%), and travel history (n = 638, 15.5%). Despite pre-screening, 569 donors (72.8%) who completed the in-person clinical assessment were ultimately deferred due primarily to potentially microbiome-mediated diseases (n = 187, 32.9%). A notably small portion of donors (n = 46, 25.6%) were deferred during the laboratory assessment process suggesting the clinical assessment was effective at deferring donors at higher risk for transmissible diseases. Donors lost to follow-up throughout the screening process presented a significant challenge and contributed to a notable (n = 3,117; 39.1%) portion of donor attrition. Findings were used to support recommendations for improving prospective stool donor screening programs and to provide suggestions for future research.

Fecal Microbiota Transplantation for multidrug-resistant organism: Efficacy and Response prediction

2020 ◽  
Vol 81 (5) ◽  
pp. 719-725
Author(s):  
Hye Seong ◽  
Sang Kil Lee ◽  
Jae Hee Cheon ◽  
Dong Eun Yong ◽  
Hong Koh ◽  
...  
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Response Prediction ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Resistant Organism

scholarly journals Stool Banking for Fecal Microbiota Transplantation: Methods and Operations at a Large Stool Bank

2021 ◽  
Vol 11 ◽  
Author(s):  
Justin Chen ◽  
Amanda Zaman ◽  
Bharat Ramakrishna ◽  
Scott W. Olesen
Keyword(s):  
Median Time ◽  
Fecal Microbiota Transplantation ◽  
Improve Patient Care ◽  
Fecal Microbiota ◽  
Screening Guidelines ◽  
Donor Screening ◽  
Clostridioides Difficile ◽  
Improve Patient ◽  
Material Preparation ◽  
Stool Bank

ObjectivesFecal microbiota transplantation (FMT) is a recommended therapy for recurrent Clostridioides difficile infection and is being investigated as a potential therapy for dozens of microbiota-mediated indications. Stool banks centralize FMT donor screening and FMT material preparation with the goal of expanding access to FMT material while simultaneously improving its safety, quality, and convenience. Although there are published consensuses on donor screening guidelines, there are few reports about the implementation of those guidelines in functioning stool banks.MethodsTo help inform consensus standards with data gathered from real-world settings and, in turn, to improve patient care, here we describe the general methodology used in 2018 by OpenBiome, a large stool bank, and its outputs in that year.ResultsIn 2018, the stool bank received 7,536 stool donations from 210 donors, a daily average of 20.6 donations, and processed 4,271 of those donations into FMT preparations. The median time a screened and enrolled stool donor actively donated stool was 5.8 months. The median time between the manufacture of an FMT preparation and its shipment to a hospital or physician was 8.9 months. Half of the stool bank’s partner hospitals and physicians ordered an average of 0.75 or fewer FMT preparations per month.ConclusionsFurther knowledge sharing should help inform refinements of stool banking guidelines and best practices.

scholarly journals 1172. Travel-Associated Multidrug-Resistant Organism Acquisition and Risk Factors Among US Military Personnel

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S354-S354
Author(s):  
Gregory Buchek ◽  
Katrin Mende ◽  
Kalyani Telu ◽  
Susan J Kaiser ◽  
David R Tribble ◽  
...  
Keyword(s):  
Risk Factors ◽  
Military Personnel ◽  
Multidrug Resistant ◽  
International Travel ◽  
Incidence Density ◽  
Resistant Organism ◽  
E Coli ◽  
Us Military ◽  
Real Time Identification ◽  
Combat Casualties

Abstract Background International travel is a risk factor for incident colonization with extended spectrum β-lactamase (ESBL)-producing organisms. These and other multidrug-resistant (MDR) bacteria are major pathogens in combat casualties. We evaluated risk factors for colonization with MDR bacteria in US military personnel traveling internationally for official duty. Methods TravMil is a prospective observational study enrolling subjects presenting to military travel clinics. We analyzed surveys, antimicrobial use data, and pre- and post-travel self-collected perirectal swabs in military travelers to regions outside the continental United States, Canada, Western or Northern Europe, or New Zealand presenting to one clinic from December 2015 to December 2017. Gram-negative isolates recovered from swabs underwent real-time identification and susceptibility testing (BD Phoenix). Characteristics of trip and traveler were analyzed to determine risk factors for MDR organism colonization. Results One hundred ten trips were planned by 99 travelers (74% male, median age 38 years [IQR 31, 47.25]); 72 trips were completed by 64 travelers. Median trip duration was 21 days (IQR 12.75, 79.5). Of those with trips completed, 17% traveled to Mexico/Caribbean/Central America, 15% to Asia, 57% to Africa, and 10% to South America; 56% stayed in hotels and 50% in dormitories/barracks. Travelers used doxycycline (15%) for malaria prophylaxis, 11% took an antibiotic for travelers’ diarrhea (TD) treatment (fluoroquinolone 7%, azithromycin 4%). Incident MDR organism colonization occurred in eight travelers (incidence density 3.5/1,000 travel days; cumulative incidence 11% of trips [95% CI: 4%–19%]), all ESBL-producing E. coli. A higher incidence of ESBL-producing E. coli acquisition was associated with travel to Asia (36% vs. 7%, P = 0.02) but not with travel to other regions, TD, or use of antimicrobials. No relationship was seen between fluoroquinolone or doxycycline exposure and resistance to those antimicrobials. Conclusion Consistent with other studies of US military personnel travelers, incident colonization with MDR organisms following official travel occurs at a lower rate in this population compared with civilian travelers, with no identified modifiable risk factors. The highest incidence of ESBL acquisition was observed during travel to Asia. Disclosures All authors: No reported disclosures.

scholarly journals Fecal Microbiota Transplantation and Successful Resolution of Multidrug-Resistant-Organism Colonization

2015 ◽  
Vol 53 (6) ◽  
pp. 1986-1989 ◽  
Author(s):  
Nancy F. Crum-Cianflone ◽  
Eva Sullivan ◽  
Gonzalo Ballon-Landa
Keyword(s):  
Clostridium Difficile ◽  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Resistant Organism ◽  
Content Type ◽  
Multidrug Resistant Organisms ◽  
Successful Resolution ◽  
Potential Measure

We report a case in which fecal microbiota transplantation (FMT) utilized for relapsingClostridium difficilecolitis successfully eradicated colonization with several multidrug-resistant organisms (MDROs). FMT may have an additive benefit of reducing MDRO carriage and should be further investigated as a potential measure to eradicate additional potentially virulent organisms beyondC. difficile.

scholarly journals Impact of Amoxicillin-Clavulanate followed by Autologous Fecal Microbiota Transplantation on Fecal Microbiome Structure and Metabolic Potential

mSphere ◽  
2018 ◽  
Vol 3 (6) ◽  
Author(s):  
Christopher Bulow ◽  
Amy Langdon ◽  
Tiffany Hink ◽  
Meghan Wallace ◽  
Kimberly A. Reske ◽  
...  
Keyword(s):  
Resistance Gene ◽  
Fecal Microbiota Transplantation ◽  
Multidrug Resistant ◽  
Fecal Microbiota ◽  
Taxonomic Composition ◽  
Gene Content ◽  
Resistant Organism ◽  
Metabolic Capacity ◽  
Metabolic Potential ◽  
Healthy State

ABSTRACTStrategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one’s feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity after exposure to amoxicillin-clavulanic acid (Amox-Clav). Ten healthy participants were enrolled. All received 5 days of Amox-Clav. Half were randomized to autoFMT, derived from stool collected pre-antimicrobial exposure, by enema, and half to saline enema. Participants submitted stool samples pre- and post-Amox-Clav and enema and during a 90-day follow-up period. Shotgun metagenomic sequencing revealed taxonomic composition, resistance gene content, and metabolic capacity. Amox-Clav significantly altered gut taxonomic composition in all participants (n= 10,P < 0.01); however, only three participants exhibited major changes at the phylum level following exposure. In the cohort as a whole, beta-lactamase genes were enriched following Amox-Clav (P < 0.05), and predicted metabolic capacity was significantly altered (P < 0.01). Species composition, metabolic capacity, and beta-lactamase abundance returned to pre-antimicrobial exposure state 7 days after either autoFMT or saline enema (P > 0.05, compared to enrollment). Alterations to microbial metabolic capacity occurred following antimicrobial exposure even in participants without substantial taxonomic disruption, potentially creating open niches for pathogen colonization. Our findings suggest that metabolic potential is an important consideration for complete assessment of antimicrobial impact on the microbiome. AutoFMT was well tolerated and may have contributed to phylogenetic recovery. (This study has been registered at ClinicalTrials.gov under identifier NCT02046525.)IMPORTANCEThe spread of multidrug resistance among pathogenic organisms threatens the efficacy of antimicrobial treatment options. The human gut serves as a reservoir for many drug-resistant organisms and their resistance genes, and perturbation of the gut microbiome by antimicrobial exposure can open metabolic niches to resistant pathogens. Once established in the gut, antimicrobial-resistant bacteria can persist even after antimicrobial exposure ceases. Strategies to prevent multidrug-resistant organism (MDRO) infections are scarce, but autologous fecal microbiota transplantation (autoFMT) may limit gastrointestinal MDRO expansion. AutoFMT involves banking one’s feces during a healthy state for later use in restoring gut microbiota following perturbation. This pilot study evaluated the effect of amoxicillin-clavulanic acid (Amox-Clav) exposure and autoFMT on gastrointestinal microbiome taxonomic composition, resistance gene content, and metabolic capacity. Importantly, we found that metabolic capacity was perturbed even in cases where gross phylogeny remained unchanged and that autoFMT was safe and well tolerated.

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